Criteria For Substance Use Disorder Research Articles

Childhood abuse and craving in methamphetamine-dependent individuals: the mediating role of alexithymia.

Individuals with a history of childhood abuse (CA,including neglect and abuse by caregivers before the age of 18years) have more severe substance dependence problems than those without a history of childhood abuse. However, whether a history of CA exacerbates craving and the mechanism of this effect remain largely unknown. The aim of this study was to explore the role of alexithymia in the effects of CA on craving in a large sample of methamphetamine-dependent individuals based on latent vulnerability theory. A total of 324 methamphetamine-dependent individuals who met DSM-5 criteria for substance use disorder were recruited. CA, alexithymia, and craving data were collected from the Childhood Trauma Questionnaire, the Toronto Alexithymia Scale-20, and the Obsessive Compulsive Drug Use Scale, respectively. t tests and ANCOVA were conducted to compare variables between the CA and non-CA groups, while partial correlation and mediation analyses were conducted to examine the potential mediating role of alexithymia in the relationship between CA and craving. Abused methamphetamine-dependent individuals reported higher levels of craving and higher levels of alexithymia than those of non-abused methamphetamine-dependent individuals. Alexithymia partially mediated the link between CA and craving, especially the effect of CA on craving frequency was fully mediated by alexithymia. Our findings reveal that a history of childhood abuse has a lasting effect on craving in stimulant-dependent individuals, and alexithymia contributes to some extent to the severity of substance abuse problems in abused methamphetamine-dependent individuals.

Prevalence of Kratom Use Disorder among Kratom Consumers.

Kratom leaf products are increasingly consumed in the United States, with many consumers reporting they experience beneficial effects from kratom use. However, there is a growing concern for kratom's potential to result in dependence when used regularly. As such, we sought to assess, using Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), diagnostic criteria for substance use disorder, the prevalence of "kratom use disorder" (KUD) among kratom consumers. Our cross-sectional study used an online, anonymous survey between February and May 2023. Through nonprobability sampling, we recruited people older than 18 years who currently consume kratom. Participants were asked about their kratom consumption patterns, adverse effects perceived to stem from kratom consumption, comorbid diagnoses, and components for a DSM-5, substance use disorder, adapted for kratom. Among the total sample (N = 2061), KUD criteria were met by 25.5% of participants (n = 525); the most commonly reported symptoms were tolerance (n = 427, 81.3%) and withdrawal (n = 357, 68.0%). After adjusting for age, gender, daily frequency of kratom consumption, and history of either a substance use disorder or a mental health condition, those with a concurrent diagnosis of another substance use disorder had 2.83 times higher odds of meeting KUD criteria (95% CI, 2.19-3.67) compared with those without one. In this large cross-sectional study, most participants who met the criteria for a KUD diagnosis were categorized as having a mild or moderate KUD. Individual characteristics associated with KUD were related to being male, young, consuming kratom frequently, and having psychiatric and substance use disorder comorbidities.

Opioid use disorders attributed to heroin and tramadol: sociodemographic and clinical similarities and differences

ABSTRACT Background and objective Tramadol misuse is a public health problem in Egypt. The objective of this study was to compare differences between patients with tramadol misuse and patients with heroin use regarding sociodemographic and clinical correlates. Methods This cross-sectional study included 58 consecutive male patients with heroin use and 37 male patients with tramadol misuse. Patients were assessed by a structural interview of SCID-I of DSM-IV-TR criteria for substance use disorders and comorbid psychiatric disorders. Patients were screened for drugs using a urine test. Results Patients with tramadol misuse were more likely to be older, to have higher education level, to be married and have a skilled profession than patients with heroin use. Patients with heroin use were more likely to have a higher smoking rate, younger age of onset of smoking, higher family history of substance use disorders, higher incarceration rate than patients with tramadol misuse. Conclusions Patients with tramadol misuse have more similarities than differences compared to patients with heroin use. Although tramadol has a dual mechanism of action and is seen as a molecule with low misuse potential it should be treated as an opioid use disorder.

Comparing the Performance of World Mental Health Composite International Diagnostic Interview Substance Abuse Module in Adolescents to Diagnoses Made by Pediatric Addiction Medicine Specialists.

The World Mental Health Composite International Diagnostic Interview Substance Abuse Module (WMH-CIDI-SAM) is commonly used as a criterion standard measure for substance use disorder (SUD) diagnoses, although the accuracy of this tool when used with adolescents is unknown. The objective of this study was to evaluate the agreement between SUD diagnoses for adolescents made by WMH-CIDI-SAM and those made by specialists based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) ( DSM-5 ) SUD criteria during an SUD evaluation. Adolescents aged 12 to 17 years presenting to an outpatient SUD program for youth were administered the WMH-CIDI-SAM by a trained research assistant, and results were compared with diagnoses made by experienced clinicians based on DSM-5 SUD criteria during an initial SUD evaluation. Chance-corrected concordance was estimated using the κ coefficient for the comparisons. The level of concordance between the WMH-CIDI-SAM interview and the clinician diagnosis based on DSM-5 SUD criteria were fair to moderate for alcohol use disorder and tobacco use disorder and poor for cannabis use disorder. Three of 11 WMH-CIDI-SAM item constructs showed poor concordance with clinician diagnosis. Interpreting the diagnostic criteria for SUDs, particularly cannabis use disorders, is nuanced, and the meaning of the criteria may be misunderstood by adolescents. Further evaluation of the performance of the WMH-CIDI-SAM diagnostic interview for identifying cannabis use disorders in adolescents is needed.

Problematic coffee use and associated factors among medical and health science students in Dilla University, Ethiopia.

Coffee holds a cherished place in Ethiopian culture, its consumption among students raises concerns despite its perceived benefits for alertness and productivity. Moderate caffeine intake remains unproblematic, but exceeding 400 mg daily can trigger detrimental health effects such as fatigue, memory impairment, and even attention-deficit disorder. Research on problematic coffee use among young adults, specifically Ethiopian students, remains limited, hindering our understanding of its potential scope and impact. To address this knowledge gap, researchers at Dilla University, Ethiopia, undertook a comprehensive study in 2022, focusing on the university's student population. This investigation holds significant potential to unveil the previously obscured landscape of excessive coffee consumption in this demographic and inform future research and potential interventions. An institutional-based cross-sectional study design was conducted in August-July, 2022. To measure problematic coffee use, this study used the Diagnostic Statistical Manual five criteria for substance use disorder. Those who scored >2 out of 11 criteria were considered to have problematic coffee use. To measure a significant association between the outcome and independent variable, a multivariable logistic regression analysis at p < 0.05 and 95% confidence interval was employed. This study included 414 respondents. More than half of the respondents, 347 (59.7%) were male. Out of all respondents, 182 (44.0%) had a boy/girlfriend. Nearly half of the respondents, 218 (52.7%) were orthodox, Christian religion followers. According to this study's findings, 137 (33.1%) respondents were considered to have problematic coffee use. Multivariable logistic regression analysis showed that 5-10 years duration of coffee use (AOR = 4.62, 95% CI: 2.96-7.85; p = 0.001), start to use coffee before joining university (AOR = 2.977, 95% CI: 1.332-6.653; p = 0.008) and 6-9 cups of daily coffee use (AOR = 3.26, 95% CI: 2.14-5.89; p = 0.00) were associated with problematic coffee use. This study showed that one-third of the respondents had problematic coffee use. The starting point, duration, and amount of use had a strong association with problematic coffee use. Hence, focusing on addressing the mental health challenges associated with problematic/excessive coffee consumption among higher education students is advisable. Additionally, promoting awareness of problematic/excessive coffee use and its potential remedies is recommended.

Context of substance initiation among urban Native Americans: an exploratory retrospective case-control study.

Addiction is a significant problem among many Native American groups but has rarely been examined in urban populations. In particular, little is known about the context in which urban Native Americans first use substances. This study compares cases (people with a history of addiction) to controls (people without a history of addiction) on demographics, substance use history, context of first substance use, and polysubstance use. In addition, this appears to be the first study to overcome the lack of Native American professionals by employing and training lay community members to identify criteria of substance use disorders in survey participants. Employing community members helped foster trust that enabled the revelation of sensitive and often illegal activity. As a result, the investigators were able to recruit participants who likely would not have engaged with traditional researchers. The trained Native American lay research assistants recruited community members and administered surveys. They first asked questions regarding the criteria for substance use disorders. Individuals who were determined to have met criteria for a substance use disorder in the past were classified as cases (n=38) and those who never met such criteria were classified as controls (n=42). They then asked demographic, substance use, and polysubstance use questions. Lastly, eight cases and eight controls were randomly selected for a second interview by a licensed drug and alcohol counselor (LDAC) who conducted a blinded assessment regarding the presence or absence of a history of a substance use disorder. Both groups reported a relatively young age of first substance use (age 16 years for cases and age 15 years for controls). Alcohol was the first substance most commonly used in both groups. Controls reported first benzodiazepine use at a younger age than cases but no other significant differences were found. Both groups reported first obtaining their first drug from family, friends, or at home (rather than a party, bar, or store). Most commonly, the location of their first use of drugs occurred at a friend's home, a party, a bar, or school rather than at their own home. Cases were marginally more likely to report that their first drug use occurred with a friend rather than with a family member when compared with controls. The majority of both groups reported that their first drug use occurred with other Native Americans rather than with non-Native Americans. Polysubstance use was common in both groups (43-45%). There were no significant differences between the groups regarding polysubstance use. The LDAC arrived at the same determination as the trained research assistants on all eight cases and eight controls.

Does nitrous oxide addiction exist? An evaluation of the evidence for the presence and prevalence of substance use disorder symptoms in recreational nitrous oxide users.

Prevalence of nitrous oxide (N2 O) use appears to be increasing in numerous countries worldwide, and excessive use has been associated with physical and mental problems. Because there currently is no consensus whether N2 O has addictive potential, we aimed to evaluate the evidence for the presence and prevalence of DSM-5 substance use disorder (SUD) symptoms in N2 O users. A literature search was conducted to assess the evidence for the presence of any of the 11 DSM-5 SUD symptoms in N2 O users and the prevalence experiencing those symptoms. A substantial part of the studied N2 O users use more than intended (i.e. 46% to 98%) and spend a substantial amount of time using N2 O. At least some of the studied N2 O users experience interpersonal problems (i.e. 13% to 80%) and use N2 O in risky situations, such as driving under the influence. Evidence for the other criteria is either insufficient or inconclusive. The literature base for the presence and prevalence of DSM-5 substance use disorder (SUD) symptoms in nitrous oxide(N2 O) users is limited and largely consists of qualitative studies and case studies, but it provides consistent evidence for the presence of at least four SUD criteria in heavy N2 O users. N2 O could well be addictive and should be treated as a potentially addictive substance until systematic assessments can provide evidence-based guidance to users, healthcare professionals and legislators.

Correlates of Past Childhood Homelessness in a Nationally Representative Sample of US Adults.

Limited empirical data have been available on the adult sequelae of childhood homelessness. Using nationally representative data from the National Epidemiologic Survey of Alcohol and Related Conditions-III, we compared a hierarchy of adults who were never homeless, those who were only homeless as children, and those who were homeless both as children and adults, hypothesizing greater adversity as one moved up the three-level hierarchy on sociodemographic, behavioral, and lifetime mental health diagnostic characteristics. As a further evaluation of the status of adults who were homeless as both children and adults, we compared this highest risk group to those who had been homeless only as adults. Individuals who experienced childhood homelessness were 46.9 times more likely than others to also experience adult homelessness. Testing the hierarchical hypothesis, compared with those who were never homeless, individuals who experienced homelessness only as children reported numerous associated disadvantages, including childhood sexual abuse/neglect, parental adversities, adult incarceration, psychiatric disorders, and low academic achievement/employment. Those reporting both child and adult homelessness, in contrast to childhood homelessness alone, additionally met the criteria for multiple substance use disorders, confirming our hierarchical hypothesis. Those reporting both child and adult homelessness also showed more numerous social and psychiatric problems when compared with those experiencing homelessness for the first time as adults. This study demonstrates how homelessness in childhood is associated with extensive social and psychiatric adversities in both childhood and adulthood.

Does food use disorder exist? Item response theory analyses of a food use disorder adapted from the DSM-5 substance use disorder criteria in a treatment seeking clinical sample

BackgroundIncreased consumption of food that are high in energy and sugar have been pointed as a major factor in the obesity epidemic. Impaired control of food intake and the concept of food addiction has been developed as a potential contributor. Our objective was to evaluate the dimensionality and psychometric validity of diagnostic criteria for food addiction adapted from the 11 DSM-5 substance use disorder (SUD) criteria (i.e.: Food Use Disorder (FUD) criteria), and to evaluate the influence of age, gender, and body mass index (BMI). MethodsCross-sectional observational study including 508 participants (56.1% male; mean age 42.2) from outpatient treatment clinics for obesity or addiction disorders at time of admission. FUD diagnostic criteria were analyzed using confirmatory factor and 2-parameter item response theory analyses. Differential Item and Test Functioning analyses were performed across age, gender, and BMI. ResultsWe demonstrated the one-factor dimensionality of the criteria set. The criterion “craving” presented the strongest factor loading and discrimination parameter and the second-lowest difficulty. We found some significant uniform differential item functioning for body mass index. We found some differential test functioning for gender and BMI. ConclusionsThis study reports, for the first time, the validity of a potential Food Use Disorder (derived from the 11 DSM-5 SUD criteria adapted to food) in a sample of treatment seeking adults. This has great implications both at the clinical level and in terms of public health policy in the context of the global obesity epidemic.

Eating Causes Clinically Significant Distress: Food Addiction as a Disordered Belief in Anorexia Nervosa?

Anorexia nervosa (AN) is characterized by an intense fear of weight gain, dietary restriction resulting in a significant weight loss compared with what is expected, and a disturbance in body image on a psychological basis. Recently, cases of AN associated with food addiction (FA) were described in almost all patients (69%), bringing a controversial aspect to the restrictive subtype (AN-r) that, in theory, even in the absence of binge eating, would present difficulties regarding control. Objectives: To report a case of an adolescent with AN-r associated with FA. Methods: Clinical history, current status, psychiatric diagnosis, and scores on scales to assess FA, food craving, and binge eating were analyzed. Results: This case report emphasizes the importance of new diagnostic tools to identify FA and whether it exists in people with AN-r beyond distress regarding eating behavior, cravings, and guilt. Eating behavior also presents a negative value that delays the elaboration process and the emergence of food cravings. In addition, an analysis of the association between the diagnostic criteria for substance use disorder, binge eating disorder, anorexia nervosa, and bulimia nervosa with the Yale Food Addiction Scale statements and criteria was discovered. Conclusions: Based on the characteristics of AN, emotional dysregulation and eating difficulties seem to overlap with FA symptoms.

Alcohol use disorder treatment delivered outside hepatology clinic.

Alcohol use disorder treatment delivered outside hepatology clinic.

Prevalence of substance use disorders and associations with mindfulness, impulsive personality traits and psychopathological symptoms in a representative sample of adolescents in Germany.

Adolescence is a critical phase for the development of substance use disorders (SUDs). For Europe and Germany, there are limited data on problematic substance use from representative youth samples. Trait mindfulness is relevant in buffering against substance use-related problems and associated deficits in self-regulatory control. The objective of this study is to estimate 12-month prevalence rates for SUDs in a representative sample of adolescents in Germany and to examine associations with mindfulness and related factors such as stress, impulsivity, sensation seeking and symptoms of psychopathology. A sample of 4001 adolescents aged 12-18years from Germany was surveyed based on DSM-IV diagnostic criteria for SUDs. Logistic regression analyses were used to examine associations with mindfulness-related variables. Criteria of at least one of the assessed SUDs were endorsed by 11.2% of the adolescents. Alcohol use disorders had the highest prevalence rate (10.1%) followed by cannabis use disorders (2.6%). For both substances, the criteria for abuse were met about twice as often as those for dependence. The prevalence of cigarette dependence was 1.7%, while the prevalence for e-cigarette dependence was only 0.1%. Prevalence rates were higher for male youth and increasing with age. SUD prevalence was also related to mindfulness, impulsivity and sensation seeking and externalizing symptoms of psychopathology. The statistically significant associations varied across different SUDs. SUDs appear highly prevalent among German adolescents. The results have public health implications with regard to treatment needs and prevention measures in the youth population in Germany.

Adolescent predictors of psychiatric disorders in adulthood: The role of emotional distress and problem drinking in emerging adulthood.

The current study evaluated risk factors in adolescence on problem drinking and emotional distress in late adolescence and emerging adulthood, and meeting criteria for diagnosed disorders in adulthood. The study included 501 parents and their adolescent who participated from middle adolescence to adulthood. Risk factors in middle adolescence (age 18) included parent alcohol use, adolescent alcohol use, and parent and adolescent emotional distress. In late adolescence (age 18), binge drinking and emotional distress were assessed, and in emerging adulthood (age 25), alcohol problems and emotional distress were examined. Meeting criteria for substance use, behavioral, affective, or anxiety disorders were examined between the ages of 26 and 31. Results showed parent alcohol use predicted substance use disorder through late adolescent binge drinking and emerging adulthood alcohol problems. Behavioral disorders were indirectly predicted by adolescent and emerging adult emotional distress. Affective disorders were indirectly predicted by parent emotional distress through adolescent emotional distress. Finally, anxiety disorders were predicted by parent alcohol use via adolescent drinking; parent emotional distress via adolescent emotional distress, and through adolescent alcohol use and emotional distress. Results provided support for the intergenerational transmission of problem drinking and emotional distress on meeting criteria for diagnosed psychiatric disorders in adulthood.

The centrality of craving in network analysis of five substance use disorders

Background and aimsAmong the 11 current diagnostic criteria, craving is a potential central marker for understanding and for treatment of Substance Use Disorders (SUD). Our objective was to explore craving centrality across SUD based on the study of symptom interactions in cross-sectional network analyses of DSM-5 SUD diagnostic criteria. We hypothesized the centrality of “Craving” in SUD across substance types. DesignParticipants from the ADDICTAQUI clinical cohort with regular use (2 times per week threshold for a substance) and at least one DSM-5 SUD. SettingOutpatient substance use treatment services in Bordeaux, France. ParticipantsThe sample of 1359 participants, had a mean age of 39 years old and 67% were males. The prevalence of SUD over the time course of the study was: 93% for alcohol, 98% for opioids, 94% for cocaine, 94% for cannabis and 91% tobacco. MeasurementsConstruction of a Symptom Network Model conducted on the DSM-5 SUD criteria evaluated over the past 12 months for Alcohol-, Cocaine-, Tobacco-, Opioid- and Cannabis Use disorder. FindingsThe only symptom that consistently remained in terms of centrality was “Craving” [3.96 – 6.17] (z-scores), indicating that it exhibits a high degree of connections in the entire symptom network regardless of the substance. ConclusionIdentifying craving as central in SUD symptoms network confirms the role of craving as a marker of addiction. This constitutes a major avenue in the understanding of the mechanisms of addiction, with implications to ameliorate diagnostic validity and clarify treatment targets.

Understanding the therapeutic factors of the social reintegration treatment stage in a residential treatment setting: a qualitative approach

PurposeThe purpose of this paper is to understand deeply the important elements of the reintegration phase of recovery.Design/methodology/approachThe participants were 14 people suffering from addiction to drugs, who met the criteria for substance use disorder according to the diagnostic and statistical manual of mental disorders, fifth edition. The data obtained by semi-structured interview were qualitatively analyzed by interpretive phenomenological analysis.FindingsThe results highlight the importance of relationships in therapy, identity reshaping, a deeper understanding of the causes of substance use, the importance of boundaries, the critical parameters of the transition to regularity and the important role of emotions.Originality/valueThe results are discussed on the basis of the enhancement of the therapeutic interventions that are followed at the reintegration stage, taking into account not only the peculiarities of this phase but also social factors such as stigmatization.

Diagnostic accuracy of the Child and Adolescent Symptom Inventory (CASI-4R) substance use subscale in detecting substance use disorders in youth.

Identifying substance use disorders (SUDs) early and accurately improves case formulation and treatment. Previous studies have investigated validity and reliability of the Child and Adolescent Symptom Inventory (CASI) for anxiety, mood, and behavior problems. The present study's aim was to test if the embedded CASI Substance Use (SU) subscale can discriminate adolescents and young adults (AYA) with and without a SUD diagnosis accurately enough to justify clinical application within an evidence-based assessment framework. N = 479 outpatient AYA (age 14-21) and their caregivers completed K-SADS-PLW semistructured diagnostic interviews; caregivers completed the CASI and adolescents completed a parallel version, the Youth (self-report) Inventory (YI). K-SADS-PLW indicated that 33 youth met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for SUDs. Receiver Operating Characteristic (ROC) analyses found that both CASI and YI Substance Use subscale scores significantly identified K-SADS-diagnosed SUDs in AYA: Caregiver area under curve (AUC) = .91, p < .0005; YI(AUC) = .90, p < .0005. There was no significant difference in diagnostic accuracy between informants. Both subscales showed diagnostic and clinical utility in identifying AYA SUDs in outpatient mental health settings. Findings suggest that the CASI-4R subscale could be a helpful screening instrument for AYA SUDs. A case vignette illustrates the clinical application of study findings. Future research should examine rapport as a moderator of reporting accuracy, and replicate use of these measures under varying clinical scenarios. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Impact of substance use disorders on employment for veterans.

Approximately 1.1 million veterans meet criteria for substance use disorders (SUDs) with 1 in 4 struggling with illicit drugs, 4 in 5 struggling with alcohol use, and 1 in 13 struggling with both. The purpose of this study was to examine the impact of SUDs on closure status (exiting with employment, did not exit with employment) for veterans served in a Department of Veterans Affairs' Veterans Health Administration (VHA) vocational rehabilitation (VR) program. Data (N = 2,620) from a VHA VR program in the Veterans Integrated Service Network 12 network were obtained for the purpose of the present study and consisted of veterans enrolled from 2012 to 2018. Findings showed that veterans without SUDs were more likely to exit with employment, and veterans enrolled in transitional work and community-based employment were more likely to exit with employment compared to those within supported employment (SE). Given that SE helps to serve veterans with the most severe psychological or medical conditions (e.g., active psychosis, schizophrenia, bipolar disorder, spinal cord injury, traumatic brain injury), findings suggest veterans are more successful with less serious mental health conditions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychoactive Substance Use Disorder in HIV-Infected Adolescents in Botswana: A Comparison Between the Congenitally Infected and Behaviorally Infected Adolescents.

Substance use is a major obstacle to preventing and managing HIV among adolescents, who account for 30% of new infections in many parts of the world, including Botswana. Unfortunately, there is a paucity of data on adolescent substance use, especially in the region. Therefore, this study aimed to determine the pattern of psychoactive substance use in adolescents living with HIV (ALWHIV). It also aimed to compare and explore the pattern of substance use disorders and associated factors between congenitally infected adolescents (CIAs) and behaviorally infected adolescents (BIAs). Six hundred and thirty-four ALWHIV were interviewed using a sociodemographic questionnaire, the WHO drug questionnaire, and DSM-5 criteria for substance use disorder. The participants' mean age (SD) was 17.69 (1.6) years, with a male predominance (n = 336, 53%), and the majority (n = 411, 64.8%) were CIAs. Alcohol was the most used substance among the participants, with 15.8% admitting to its current use. The BIAs were more likely to have SUD (χ2 = 17.2, P < .01), use more than one substance (χ2 = 20.3, P < .01), and more likely to use all psychoactive substances except for inhalants. In the CIAs, regular participation in religious activities was negatively associated with SUD (AOR = 0.36; 95% CI: 0.17-0.77), while struggling with HIV status acceptance was positively associated with SUD (AOR = 2.54; 95% CI: 1.15-5.61) in the BIAs. This study showed a huge burden and similar pattern of substance use disorders among the ALWHIV in Botswana, as reported elsewhere. It also identified the dissimilarities between the BIAs and CIAs regarding substance-related issues and suggested the need for differentiated care.

Gaps and barriers in drug and alcohol treatment following implementation of the affordable care act

BackgroundThis study examines changes in the substance use disorder (SUD) treatment gap and barriers to treatment for low-income adults following Affordable Care Act (ACA) implementation. MethodsNational Survey on Drug Use and Health (NSDUH) data were pooled to assess pre-ACA (2009–2013) and post-ACA (2015–2019) implementation. The sample (n = 44,622) included respondents 18–64 years old, income <200% federal poverty level, and meeting SUD criteria for abuse or dependence of heroin, powdered cocaine, crack cocaine, marijuana, or alcohol. The primary outcome was NSDUH-defined past-year illicit drug or alcohol treatment gap (needing but not receiving SUD specialty treatment). A secondary analysis assessed barriers to SUD treatment including insurance-related barriers, stigma, barriers to access, priority of treatment, and no interest in stopping substance use. ResultsNinety-three percent of respondents reported a drug or alcohol treatment gap before and after ACA implementation. No interest in stopping use was the greatest barrier (40%), followed by insurance-related barriers (39%) and stigma (20%). After adjusting for covariates, results did not show a significant change in SUD treatment gap post-ACA compared to pre-ACA (adjusted odds ratio [aOR]=1.11, 95% confidence interval [CI]=0.97, 1.28, p = 0.13). Compared to pre-ACA, odds of reporting stigma-related barriers (aOR=1.66, 95% CI=1.17, 2.37, p = 0.01) and access-related barriers (aOR=1.79, 95% CI=1.34, 2.38, p < 0.001) increased post-ACA. ConclusionsThere was no significant change in the prevalence of SUD treatment gap after ACA implementation. Increasing access to SUD treatment for low-income individuals will require intervening at multiple socioecological levels beyond reforming treatment financing.

Natural Language Processing for Computer-Assisted Chart Review to Assess Documentation of Substance use and Psychopathology in Heart Failure Patients Awaiting Cardiac Resynchronization Therapy.

Advanced heart failure (HF) patients often experience distressing psychological symptoms, frequently meeting diagnostic criteria for psychological disorders, including anxiety, depression, and substance use disorder. Patients with device-based HF therapies have added risk for psychological disorders, with consequences for their physiological functioning, including adverse cardiac outcomes. This study used natural language processing (NLP) for computer-assisted chart review to assess documentation of mental health and substance use in HF patients awaiting cardiac resynchronization therapy (CRT), a device-based HF therapy. We applied NLP to clinical notes from electronic health records (EHR) of 965 consecutive patients, with 9821 total clinical notes, at two academic medical centers between 2004 and 2015. We developed and validated a keyword library capturing terms related to mental health and substance use, while balancing specificity and sensitivity. Mean age was 71.6 years (SD = 11.8), 78% male, and 87% non-Hispanic White. Of the 544 patients (56.4%) with documentation of mental health history, 9.7% had their mental health assessed and 6.6% had a plan documented. Of the 773 patients (80.1%) with documentation of substance use history, 10 (1.0%) had an assessment, and 3 (0.3%) had a plan. Despite clinical recommendations and standards of care, clinicians are under documenting assessments and plans prior to CRT. Future research should develop an algorithm to prompt clinicians to document this content. Such quality improvement efforts may ensure adherence to standards of care and clinical guidelines.